结直肠癌合并高风险性腺瘤内镜治疗时机的临床研究

Clinical study on the timing of endoscopic therapy for colorectal cancer combining with high-risk adenoma

目的针对结直肠癌合并高风险性腺瘤可择期外科手术的患者,探讨内镜下治疗的合适时机。方法收集2013年1月至2018年6月经山东省威海市立医院诊治结直肠癌合并高风险性腺瘤的患者88例,将患者分为二组。A组52例患者,伴发高风险性腺瘤共96枚,该组患者先行结直肠癌外科手术,术后半年内行内镜下高风险性腺瘤治疗;B组36例患者,伴发高风险性腺瘤共54枚,该组患者先行结直肠高风险性腺瘤内镜下治疗,1~2周后再行结直肠癌外科手术治疗。分别记录患者的术前情况,手术相关情况,术后3~36个月随访结肠镜检查、肿瘤复发情况。结果A组患者外科术后切除腺瘤,其中4例患者腺瘤发生癌变,均行二次外科手术进行切除、另4例患者出现吻合口复发,行二次外科手术。B组患者术前腺瘤切除术中1例出现穿孔,行外科区段切除手术,另有2例术后病理亦为腺瘤癌变侵及黏膜下层>1000μm,行外科区段切除手术,术后复查未发现吻合口复发。两组患者二次外科手术发生率对比有统计学意义(P<0.001)。结论针对结直肠癌合并高风险性腺瘤可择期外科手术的患者,先行内镜治疗结直肠腺瘤,1~2周后再行结直肠癌外科手术,可有效减少二次外科手术的发生,值得临床广泛推广。

Objective To explore the appropriate time of endoscopic treatment for colorectal cancer patients with high-risk adenomawho could be operated on electively.Methods A total of 88 patients with colorectal cancer complicated with high-risk adenoma in Weihai Municipal Hospital from January 2013 to June 2018 were collected and divided into two groups.There were 52 patients in group A,with 96 high-risk adenomas.Patients in this group underwent surgery for colorectal cancer first,and endoscopic treatment for high-risk adenomas within six months after the operation;There were 36 patients in group B,with 54 high-risk adenomas.Patients in this group were first treated with colorectal high-risk adenomas under endoscopic treatment,and then received surgical treatment for colorectal cancer 1 to 2 weeks later.And record the patient's preoperative condition,surgery-related condition,Colonoscopy and tumor recurrence were followed up 3-36 months after operation.Results In group A,the adenoma was resected after surgery,among which 4 patients developed cancerous adenomas and underwent secondary surgical resection.The other 4 patients had anastomotic recurrence and underwent secondary surgery.In group B,1 case of perforation occurred during adenoma resection.and surgical section resection was performed,the other 2 cases also showedthe adenoma became cancerous and submucosa>1000μm,and underwent surgical segmental resection,and no recurrence of anastomotic stoma was found in postoperative reexamination.The incidence of secondary surgical operations between the two groups was statistically significant(P<0.001).Conclusion For patients with colorectal cancer combined with high-risk adenomas that can be surgically operated on,endoscopic treatment of colorectal adenomas first and colorectal cancer surgery 1 to 2 weeks latercan effectively reduce the occurrence of secondary surgical operations,is worthy of widespread clinical promotion.